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  1. Most common benign lesions:
    Cavernous hemangioma - 2cm under capsule
  2. Nodular hyperplasia:
    1. Focal nodular hyperplasia
    2. Nodular regenerative hyperplasia
    3. Affects the whole liver spherical nodules without fibrosis.
    4. Plump hepatocytes are surrounded by rims of atrophic hepatocytes Q
    5. Associated with portal hypertension Focal nodular Hyperplasia: Q
    6. Young to middle age adults, female preponderance.
    7. Asymptomatic/ abd. Mass / Discomfort
    8. No malignant potential.
      Path: Well demarcated, non- encapsulated, Nodule Lighter in color than liver.
      1. Central scar with large vessels (arteries)
      2. Septae show bile duct proliferation
        Liver cell adenoma: Females (Nearly all)
        1. 3rd/4th decade    
        2. Associated with OCP use
        3. Rupture - Abd. emerg. (hemoperitoneum) acute abdominal pain
        4. LFTs (n)
        5. Path: Partial encapsulated, Yellow tan with bile staining Q
        6. Solitary, homogenous
        7. Hepatocytes: glycogen rich, vacuolated, No bile, ductules, kupffer cells Q
        8. No. portal tracts. 
  3. Malignant Tumors
    1. Hepatoblastoma
      1. Young children         
      2. Epithelial type small polygonal cells / embryonal cells forming acini tubules
      3. Mixed epithelial/mesenchymal type
      4. Contain primitive mesenchyme
    2. Angiosarcoma
      Vinyl chloride, Arsenic, Thorotrast
    3. HCC: 90% of primary carcinoma of Liver
      1. HBB and HCV infection
      2. Aflatoxin’s
      3. Cirrhosis (alcoholic Cirrhosis)/ hemo chromatosis
      4. Hereditary tyrosinemia 40% dev. HCC
      5. Universal HBV vaccination may decrease incidence of HCC
        1. Unifocal - single large mass. Q
  • Multi focal multiple nodules                
  • Diffuse Involves entire liver
  • Cells are bile stained                        
  • Tendency to invade vascular channels
  • Well poorly differentiated
  1. Fibrolamellar Ca
  • 20 - 40 years               
  • No associated with cirrhosis / HBV               
  • Better prognosis
  • H/P - Scirrhous tumor - fibrous bands and well differentiated polygonal cells in nests. Q

α FP levels are normal                             

  1. Cholangio Carcinoma - Ca. of extra/ intra hepatic biliary tree
    1. Thorotrast                   
    2. Opisthorchis sinensis
    3. Caroli's disease  
    4. Prim. Cholangitis
    5. Hepatic fibrosis            
    6. Lymphatic and vascular invasion prominent
    7. Extensive intra hepatic metastases
  2. Metastatic tumors:
    1. More common in liver than primary tumors Primary
    2. From breast, lung colon
    3. Multiple nodular implants with umbilication

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